POCUS was used to evaluate a 65-year-old male presenting with fever, chills, nausea, vomiting and back pain, and a history of kidney stones. POCUS revealed mild to moderate left hydronephrosis, a distended left ureter with a possible stone at the PUJ, and small stones in the bladder. CT confirmed ureter dilation and mild left hydronephrosis, though no stones were seen. Ureteroscopy later revealed a 1 cm calcium oxalate stone in the mid-distal ureter. POCUS findings helped establish a diagnosis of obstructive urolithiasis with infection and guided further imaging and management.
University of sydney BDent1 - Finding the best evidence. Presentations goes over How to formulate a clinical question using PICO, How to find a systematic review in Cochrane & Medline, and how to find primary studies using the Ovid clinical queries limit in Medline. Contains links to the Sutherland Evidence-based Dentistry articles from the Journal of the Canadian Dental Association.
SLC CME- Evidence based medicine 07/27/2007cddirks
Saint Luke's Care, a quality improvement organization within Saint Luke's Health System, presents a CME presentation by Dr. Brent Beasley on Evidence Based Medical Care.
This is the presentation I made to the National Cancer Institute's Cancer Research in the Media workshop for Latin American journalists in Guadalajara on November 8, 2011. It is step-by-step advice about things to consider about each of the 10 criteria we apply to the review of health care news stories about treatments, tests, products & procedures.
University of sydney BDent1 - Finding the best evidence. Presentations goes over How to formulate a clinical question using PICO, How to find a systematic review in Cochrane & Medline, and how to find primary studies using the Ovid clinical queries limit in Medline. Contains links to the Sutherland Evidence-based Dentistry articles from the Journal of the Canadian Dental Association.
SLC CME- Evidence based medicine 07/27/2007cddirks
Saint Luke's Care, a quality improvement organization within Saint Luke's Health System, presents a CME presentation by Dr. Brent Beasley on Evidence Based Medical Care.
This is the presentation I made to the National Cancer Institute's Cancer Research in the Media workshop for Latin American journalists in Guadalajara on November 8, 2011. It is step-by-step advice about things to consider about each of the 10 criteria we apply to the review of health care news stories about treatments, tests, products & procedures.
Practical Points in Emergency CT for Emergency PhysiciansRathachai Kaewlai
The handout describes some brief practical points on emergency CT, particularly for emergency physicians. They include imaging utilisation trends, radiation dose, contrast reaction, contrast-induced nephropathy, use of oral contrast medium and some caveats on emergency CT (esp. abdomen)
ICN Victoria presents Dr Dashiell Gantner, research fellow at the Monash University in Melbourne. Here he talks about translating ICU research into clinical practice.
Point of Care Testing (POCT) refers to medical testing that is conducted outside of a laboratory setting, typically near or at the location of a patient. This can include testing in a physician's office, at home, in the field, or in a hospital room. POCT is usually performed using portable, handheld, or small benchtop devices. Here are some main features and advantages of POCT:
Convenience and Speed: Since POCT can be done at or near the patient's location, it eliminates the need to send samples to a lab and wait for the results. This can result in quicker diagnosis and treatment.
Immediate Decision Making: With instant results, healthcare providers can make immediate decisions about a patient's care, leading to improved patient outcomes.
Reduced Costs: While some POCT devices can be expensive, they may reduce overall healthcare costs by shortening hospital stays, reducing the number of follow-up visits, and preventing complications.
Simplicity: Many POCT devices are designed to be user-friendly, allowing non-laboratory personnel or even patients themselves to conduct tests.
Connectivity: Modern POCT devices often come with connectivity options, enabling the integration of test results into electronic health records.
Versatility: There's a wide range of tests available for POCT, from blood glucose testing to rapid strep tests and coagulation tests.
However, it's also important to note some challenges with POCT:
Quality Control: Ensuring the accuracy and reliability of POCT results can be challenging, especially if tests are being conducted by non-laboratory personnel.
Cost: Some advanced POCT devices can be costly, and there may be additional costs associated with training and quality control.
Regulation and Oversight: Because POCT is performed outside of the traditional lab setting, there can be challenges related to oversight, regulation, and ensuring that tests meet necessary standards.
In summary, while POCT offers many advantages in terms of speed and convenience, it's essential to ensure that tests are accurate, reliable, and meet necessary standards.
Rapid diagnostic tests (RDTs) in India play a crucial role in the detection and management of various diseases, including infectious diseases like malaria, dengue, and more recently, COVID-19. Here's an overview of RDTs in India:
Importance in Disease Management: In a vast and diverse country like India, with varied healthcare infrastructure across its regions, RDTs provide a quick and effective way to diagnose diseases, especially in remote areas where sophisticated laboratory setups might not be available.
Malaria and Dengue Detection: RDTs for malaria (based on the detection of antigens produced by malaria parasites) and dengue (based on the detection of dengue NS1 antigen and anti-dengue antibodies) are widely used. They offer results in less than
Rapid Diagnostic Tests (RDTs) in India play a crucial role in the quick detection and diagnosis of various diseases. They are espec
Evidence based management of osteoarthritis in primary care - Dr Jonathan Quickepcsciences
Dr Jonathan Quicke is an NIHR Academic Clinical Lecturer in Physiotherapy (Keele University). Dr Quicke presented at the 2017 Musculoskeletal Education Day, where he discussed how we can ensure that best practice can be implemented within general practice for patients suffering with osteoarthritis
To understand why a study abstract is important to scientific communication.
To understand the process by which abstracts are selected for presentation at scientific conferences.
To learn the features which unite successful abstract submissions.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
The Importance of Community Nursing Care.pdfAD Healthcare
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Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Navigating Women's Health: Understanding Prenatal Care and Beyond
Flank pain and fever
1. Flank pain and fever
A Case Discussion of Clinical Integration of POCUS
Free Open-Access Medical Education in Point of Care
Ultrasound
Produced by Pitt IM POCUS
2. Overview
Case information
• What would be your diagnostic/management plan without POCUS?
• What are your POCUS question(s)?
Images
• What is your interpretation?
• Limitations of images? How could they be improved?
Diagnostic and management discussion
• What are the next steps in diagnosis and management?
Case wrap-up
• What role did POCUS play in this case?
• How will you apply what you learned in your practice?
3. Case info
65 m w hx of BPH, kidney stones, in ED w fevers/chills/N/V/back pain. Dx acute pyelo,
possible stone
Prior dx of kidney stones on CT (6-8 mm, unknown type), managed medically. Has
intermittent L flank pain. Last 2 days - f/c/n/v/back pain.
T 38.6 HR 98 BP 154/88 SpO2 99% UA: 1+ blood, 3+ LE, WBC TNTC +L CVA and suprapubic
tenderness WBC 18 Cr 1.6 (baseline 1.3)
Pt admitted with a diagnosis of acute pyelonephritis and possible kidney stones and started
on ceftriaxone. Foley was placed with difficulty but has drained 200 cc in the few minutes
since placement
• What would be your diagnostic/management plan without POCUS?
• What are your POCUS question(s)?
4. Group Poll
It is 8PM. What would be your approach to imaging?
-if POCUS unavailable
-we will assume radiology staff not in house overnight, but could be called in
No imaging needed now
Renal US in AM
CT A/P in AM
CT A/P stat
5. Results of Twitter Poll
It is 8PM. What would be your approach to imaging?
-if POCUS unavailable
-we will assume radiology staff not in house overnight, but could be called in
No imaging needed now
Renal US in AM
CT A/P in AM
CT A/P stat
6. Decision to Perform POCUS
Note the variation in approach to imaging (when POCUS unavailable) based on the poll
currently. Probably need imaging (CT) but varying opinions on urgency.
Prior to performing POCUS , is is important emphasize the idea of the "POCUS question" i.e
what are we asking on POCUS, and will the answer help us? Some considerations
• Is the exam literature-based as a point-of-care study
• How would each possible finding change mgmt More on this later
A decision should be made to perform POCUS when it can help answer a focused question
and guide management
7. Overview
Case information
• What would be your diagnostic/management plan without POCUS?
• What are your POCUS question(s)?
Images
• What is your interpretation?
• Limitations of images? How could they be improved?
Diagnostic and management discussion
• What are the next steps in diagnosis and management?
Case wrap-up
• What role did POCUS play in this case?
• How will you apply what you learned in your practice?
12. POCUS interpretation
Point-of-Care Ultrasound
Performed MM/DD/YY
L kidney: Mild to moderate left hydronephrosis. Distended L ureter w possible stone at PUJ.
R kidney: No hydronephrosis seen
Bladder: Foley in decompressed bladder. Small stones in bladder.
13. POCUS interpretation
L kidney: Mild to mod left hydro (absence of color flow helps confirm). Distended
L ureter w possible stone at PUJ.
15. Overview
Case information
• What would be your diagnostic/management plan without POCUS?
• What are your POCUS question(s)?
Images
• What is your interpretation?
• Limitations of images? How could they be improved?
Diagnostic and management discussion
• What are the next steps in diagnosis and management?
Case wrap-up
• What role did POCUS play in this case?
• How will you apply what you learned in your practice?
17. Overview
Case information
• What would be your diagnostic/management plan without POCUS?
• What are your POCUS question(s)?
Images
• What is your interpretation?
• Limitations of images? How could they be improved?
Diagnostic and management discussion
• What are the next steps in diagnosis and management?
Hospital Course/Learning Points
• What role did POCUS play in this case?
• How will you apply what you learned in your practice?
18. Hospital Course
These POCUS findings, in this clinical setting, led to a dx of obstructive
urolithiasis with infection.
CT A/P was performed, which confirmed ureter dilation and mild-mod left
hydronephrosis. Interestingly, no stones were seen on CT.
Urine cx grew E. coli (pan-sensitive)
Urology was consulted and performed cystoscopy/ureteroscopy, which did
reveal a stone in the mid-distal ureter. The stone was extracted and noted to be
~1 cm calcium oxalate stone. Infection subsequently resolved with abx
treatment
19. Learning Points
1) When to obtain imaging in a pt with acute pyelo?
2) How do we grade hydronephrosis on POCUS?
3) How sensitive and specific is POCUS for hydronephrosis?
4) Is POCUS useful to r/o stone?
5) How do we integrate POCUS findings to affect dx in mgmt in this case?
20. 1) When to obtain imaging in a pt with acute pyelo?
In general, imaging indicated if no response to therapy (>48-72 hrs) or
complicating factor present ex: history of stone disease,
immunocompromised (see tables from ACR appropriateness criteria)
https://acsearch.acr.org/docs/69489/Narrative
21. 1) When to obtain imaging in a pt with acute pyelo?
22. 1) When to obtain imaging in a pt with acute pyelo?
23. 2) How do we grade hydronephrosis on POCUS
http://www.thepocusatlas.com/hydro-and-obstruction
24. 3) How sensitive/specific is POCUS for hydronephrosis?
• POCUS for hydronephrosis performed by IM residents had sensitivity
of >90% and specificity of > 90%
(https://www.ncbi.nlm.nih.gov/pubmed/24154905 ).
• Another study in the ED found sensitivity 86% for any hydronephrosis
and 66% specificity (next slide)
• 95% specificity for moderate or greater hydronephrosis
• Tip: Note that hydronephrosis may not be seen on initial exam (CT or
US) due to low UOP. May be worth hydrating and reassessing on
POCUS several hours later if clinical concern for obstruction persists.
25.
26. 4) Is POCUS useful for ruling out a stone?
• The simple answer – No
• Review of ED POCUS for nephrolithiasis: sensitivity ~70%, specificity ~75%
https://journalfeed.org/article-a-day/2018/pocus-for-kidney-stone-be-
careful
• However, negative POCUS scans have been associated with low rates of
stone-related adverse events (0.4%) in ED patients
https://www.nejm.org/doi/full/10.1056/nejmoa1404446
27. 5) How do we integrate POCUS findings in this case?
28. 5) How do we integrate POCUS findings in this case?
See helpful algortithm from
UpToDate here on
approach to acute
complicated UTI in the
inpatient setting
29. Case wrap-up
• What role did POCUS play in this case?
• How will you apply what you learned in your practice?
30. Take home points
• In a patient with pyelonephritis and any concern for obstruction or stone
disease, POCUS can be useful to determine whether or not hydronephrosis
(and thus, obstruction) is present.
• Hydronephrosis may not be seen on initial exam (CT or US) due to low
UOP. May be worth hydrating and reassessing on POCUS several hours
later if clinical concern for obstruction persists.
• POCUS can look for stones, but has low sensitivity and specificity and
should not be used to rule out the present of a stone.
• Remember to be clear on what exactly you are asking on POCUS, and how
possible findings will impact your approach in the practical setting.
31. Want to dive deeper into this case, or see more cases?
This case was presented by Pitt IM POCUS on twitter in May 2019. Follow this
link to see the full thread, including comments and discussion from the POCUS
MedTwitter community. We thank the MedTwitter community for
contributions to this thread.
Please follow us at @PittIMPOCUS
Follow this link for other case presentations
Any questions, please contact
Michelle Fleshner – mfleshner301@gmail.com
Steve Fox – stevefox00@gmail.com
32. This is free, open access medical education. You may download, share, modify,
and use freely when used for medical education.
Patient confidentiality is the priority in these cases, so details may be left out
or modified to prevent identification. An effort is made to maintain the
educational quality.
33. References/Additional Reading
• American College of Radiology Appropriateness Criteria. Acute
Pyelonephritis (ACR)
• UpToDate – Acute Complicated UTI (Hooton)
• Grading of Hydronephrosis (The POCUS Atlas)
• POCUS for ruling out kidney stones (Clay Smith)
• Ultrasound vs CT for Supected Nephrolithiasis (Smith-Bindman et al, NEJM)
• Sensitivity and Specificity of POCUS for hydronephrosis (Ultrasound GEL)
• Internal Medicine Resident POCUS for Hydronephrosis (Caronia et al, JUM)
